Getting Ethical

In this month’s blog I wanted to follow up on a topic that will be crucial as part of the medical school interview process; ethics. After last month’s blog where I mentioned the case of Charlie Gard, I thought it was important to dedicate this month’s blog to the topic.

Ethics is such an important topic because as a doctor, you are part of unique class of professionals that can potentially learn about, as well as directly impact, an individual’s most personal affairs. Not only will you be controlling a patient’s health (and even life), but in the process of your work may learn the most intimate details of their family, financial, and social situation. Ethics relates not only to medical decisions, but also to decisions on how we choose to use and respond to very private information that in shared with us in confidence. It is crucial to start thinking through these situations and reading up on the topic, as much as you would study any anatomical or disease related topic. What do you do if you suspect abuse in an elderly patient? Or if a minor requests access to contraception? These are questions that an interviewer could ask you at interview, and it is important to be able to respond to these questions in an eloquent and informed manner.

The question I would like to discuss today is the recurring topic of euthanasia and a patient’s “right-to-die”. I bring this up not only because of the recent Charlie Gard case, but I think it is an important one to review as it is frequently debated and a favorite topic of med school interviewers across the UK. In addition, there are many case studies that can be referred to, as well as a spectrum of laws governing end of life care globally, ranging from the very liberal to the very conservative. As a primer to this topic, I highly recommend Terry Pratchett’s documentary on assisted suicide “Choosing to Die” – it’s an emotional watch and highly personal for this beloved author who died in 2015 from Alzheimer’s.

As a British medical student, it is worth asking yourself (the common interview question) “as a British doctor, can you purposefully end a patient’s life?” The answer lies in the student understanding the difference between active and passive euthanasia and what the law says regarding both. Passive euthanasia (legal in the UK) relates to the withdrawal of life-supporting activities that without which the patient is likely to die. Active euthanasia (aka assisted suicide) is the active process of ending a person’s life who otherwise would likely continue to live if no intervention was made. This latter form of euthanasia is illegal in the UK, but is legal in some European counties such as Switzerland, where clinics such as Dignitas have frequently appeared in the media for their willingness to accept patients from abroad, such as the UK, who are seeking to end their own life but are unable to do so legally in their own countries.

There are many important and weighty arguments both for and against the topic of assisted suicide and I will not use this blog to list them all out. Rather, I implore any medical students reading this to go out and do some research on the topic and form their own opinions if they don’t already have them. I further challenge to see how their opinions might differ when taken from the perspective of being a doctor versus that of a patient, or relative to a patient suffering from a terminal illness. It is totally acceptable to go into an interview with a firm point of view on an ethics topic, but do be prepared to be challenged on it! And it is also crucial that you know what the law says on the topic. Remember, your interviewer might have their own firm views, and while they may differ from yours, you must ensure that you acknowledge and respect them. As long as there is more than one person on Earth, there will always be multiple, conflicting points of view!